ABSTRACT NM is an epicenter of the opioid crisis in the US, with one of the highest overdose mortality rates since 1990. Both heroin-attributable opioid deaths and deaths from prescription opioids have increased, especially in Hispanic and American Indian/Alaska Native groups. Many challenging social determinants, including poverty and unemployment contribute to high rates of OUD in NM. Our group is ideally suited to lead a NIDA CTN Node because of the breadth and depth of our involvement in OUD research, extensive clinical trials experience, intimate connection with the ECHO Institute and its use for expanding access to SUD treatments, links with AI/AN researchers and clinicians, our proven ability to recruit diverse rural populations to participate in research, as well as informatics and data science capacity. The Aims of the NM Node are to: 1) develop and maintain a highly efficient platform to conduct clinical trials that will inform evidence-based prevention and treatment of OUD; 2) collaborate on and lead research that addresses and improves outcomes across the OUD Cascade of Care (CoC); 3) promote uptake of best-practices in OUD prevention and care in NM and nationwide through effective dissemination of evidence-based innovations. The expected impacts will be expanded research in diverse, rural and underserved populations impacted by the opioid crisis, and increased capacity of providers and researchers to collaborate on, lead, and propose impactful research. NM Node research will ensure the development of robust and generalizable methods for prevention, identification, and treatment of OUD including evaluation and modification of the CoC expanding the local and national knowledge base. Our dissemination aim will ensure a productive cycle of engagement and translation of evidence-based practices and promote a sustained positive impact on the OUD CoC in communities in NM and nationwide. Our proposal builds on multiple assets: 1) a strong alliance with the primary care health providers in (i) an existing PBRN (RIOS Net) that extends into rural NM, (ii) UNM community-based primary care clinics; (iii) and providers of SUD/ and OUD treatment at multiple rural and urban sites across NM including over 400 that have engaged with ECHO learning networks; 2) 15 years of prior CTN and protocol management experience; 3) expertise conducting research including clinical trials with patients with SUD and OUD; 4) leadership in health services including Project ECHO, informatics, and implementation research; 5) access to unique and diverse communities and patient populations, including medically underserved, rural, Hispanic and American Indian; 6) strong clinical and educational expertise in MOUD and 7) our strength in behavioral interventions for SUD, centered in CASAA .